Objective: The purpose of this study was to examine how pre-service physical education (PE) teacher education students understand health education and their role as health educators. The challenges that a cohort of pre-service teachers (n = 20) majoring and minoring in PE face in engaging in a socially contextualised understanding of health are examined. Design: Study participants were in a semester length foundational health education course. Following ethics board approval, participants' reflective journals were accessed for data. The data were coded for themes and then analysed using Windschitl's framing of constructivism in practice. Setting: Undergraduate health education teacher education programme at an Australian university. Results: Findings reveal how PE teacher education students made meaning of socially contextualised and contested areas of health, and developed their own understanding of health education pedagogical practice. Common challenges were evidenced by the students when attempting to explain their expanding understanding of health education pedagogy and practice. Conclusion: The simple understandings and conceptual ambiguities evident in this group of students help to explain why health education taught in secondary schools by PE teachers more often takes the form of 'PE theory' than health education.